Stereotactic and functional neurosurgery
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We have reviewed our experience with spinal cord stimulation (SCS) in patients with low back and leg pain. 33 patients complaining of leg and low back pain underwent percutaneous tests of SCS. 28 patients had failed back surgery syndromes, 1 patient had pain related to an L1 vertebral body fracture, another from Tarlow cysts and the remaining 3 patients had lumbosacral spondyloarthrosis and osteoporosis without radiological signs of root compression. 28 patients showed mono- or pluriradicular deficits. At the end of the test period (5-65 days), 21 patients (63.6%) reported more than 50% of pain relief (mean analgesia 75%) and were submitted to chronic stimulation. The mean follow-up was 45.5 months. At maximum available follow-up, 40% of the patients (13 out of the 33 initial patients) were successfully using the stimulator (mean analgesia 66.6%).
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Stereotact Funct Neurosurg · Jan 1994
An experimental animal model of spinal cord stimulation for pain.
In spite of the routine usage of spinal cord stimulation (SCS) as treatment of chronic pain, there is an insufficient understanding of the mechanisms underlying its effect. The method was originally developed as a spin-off from experiments demonstrating the inhibitory control of nociceptive signals by the activation of large afferent fibers, and on the basis of these findings the gate-control theory was advanced. Later experiments showed that stimulation of the dorsal columns can inhibit the relay of nociceptive impulses to second-order neurons in the dorsal horn. ⋯ SCS was applied at the approximate level of Th-XII during 10-20 min and produced a marked augmentation of the stimulus threshold. This abnormally high threshold was not normalized until 30-60 min after the end of SCS. In awake animals SCS was applied via an implanted spinal electrode and the effect on behavior changes associated with mononeuropathy was studied.(ABSTRACT TRUNCATED AT 250 WORDS)
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Stereotact Funct Neurosurg · Jan 1994
Multicenter StudyItalian multicentric study on pain treatment with epidural spinal cord stimulation.
A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. ⋯ These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.
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Stereotact Funct Neurosurg · Jan 1994
Case ReportsUse of a frameless isocentric stereotactic system (NEURO-SAT) combined with the intraoperative microrecording.
Combining the frameless isocentric stereotactic system (NEURO-SAT) and intraoperative microrecording, we performed stereotactic biopsies of deep-seated brain tumors in two cases. Case 1 was a 58-year-old male suffering from a right thalamus to basal ganglia tumor and case 2 was a 29-year-old male suffering from brain stem tumor. ⋯ NEURO-SAT provides three-dimensional real-time surgical navigation by displaying the positional information on the MRI images, and intraoperative microrecording shows a clear delineation between the tumor and the normal tissue in both cases. Therefore, since this combined method provides real-time surgical navigation and clear delineation of the tumor and normal tissue, it is a promising method of accurate and reliable image-directed stereotactic biopsy of deep-seated brain tumor.
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Stereotact Funct Neurosurg · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialA prospective, randomized study of spinal cord stimulation versus reoperation for failed back surgery syndrome: initial results.
Spinal cord stimulation (SCS) has been reported to be effective treatment for the failed back surgery syndrome in a number of retrospective case series. Its retrospectively reported results compare favorably with those of neurosurgical treatment alternatives, such as reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. ⋯ The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for SCS over reoperation. This is one of many potentially important outcome measures, which are to be followed long-term as a larger overall study population accrues.